Provider Demographics
NPI:1740521566
Name:PAPA, KRISTINE-CASSANDRA B (LMP)
Entity type:Individual
Prefix:
First Name:KRISTINE-CASSANDRA
Middle Name:B
Last Name:PAPA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10202 PACIFIC AVE. S
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444
Mailing Address - Country:US
Mailing Address - Phone:253-267-5238
Mailing Address - Fax:
Practice Address - Street 1:10202 PACIFIC AVE. S
Practice Address - Street 2:SUITE 215
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-267-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60319056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist